From the Guidelines
The prophylactic dose of calcium for pediatric patients, specifically those aged 4-17 years, is recommended to be 1,000 mg/day, along with a vitamin D intake of 600 IU/day, as stated in the 2017 American College of Rheumatology guideline 1. This recommendation is particularly important for children who are continuing treatment with glucocorticoids at a dose of ≥0.1 mg/kg/day for ≥3 months, as they are at risk of developing glucocorticoid-induced osteoporosis.
- The recommended calcium intake may vary depending on the age group, with infants 0-6 months requiring 200 mg, 6-12 months needing 260 mg, children 1-3 years requiring 700 mg, 4-8 years needing 1,000 mg, and 9-18 years requiring 1,300 mg daily, as suggested by other guidelines 1.
- However, the most recent and relevant guideline for pediatric patients on glucocorticoids recommends a calcium intake of 1,000 mg/day 1.
- It is essential to note that calcium supplementation should be given concurrently with vitamin D to enhance calcium absorption.
- Common calcium supplements include calcium carbonate (40% elemental calcium) and calcium citrate (21% elemental calcium), with calcium carbonate requiring food for optimal absorption and calcium citrate being taken with or without food.
- Monitoring for constipation, a common side effect, and adjusting dosing as needed is crucial.
From the Research
Calcium Requirements in Pediatric Age
- The American Academy of Pediatrics recommends that pediatric caregivers advise on the nutritional needs of calcium for infants, children, and adolescents 2.
- A systematic review of balance studies in children aged 0-4 years suggests that calcium intake of 240 to 400 mg/d may promote optimal calcium absorption with minimal loss 3.
- The review also found that calcium from human milk may lead to greater absorption and retention efficacy than formula or solid foods 3.
Calcium Supplementation
- Calcium supplementation has been found to be beneficial for bone health in children, young adults, and menopausal women 4.
- Calcium from carbonate and citrate are the most common forms of calcium supplements, with calcium carbonate being the most cost-effective form 4.
- The maximum dose of elemental calcium that should be taken at a time is 500 mg 4.
Bioavailability of Calcium Supplements
- A study comparing the bioavailability of calcium carbonate powder and calcium citrate tablets found that calcium carbonate powder resulted in greater absorption in total and ionized calcium 5.
- Another study found that cholecalciferol (vitamin D3) promotes calcium absorption, with a 16.6% increase in urinary excretion of total calcium compared to calcium alone 6.
Profalactic Dose of Calcium
- There is no specific profalactic dose of calcium recommended for pediatric age, but the studies suggest that calcium intake of 240 to 400 mg/d may be beneficial for optimal calcium absorption and bone health 3.